Preoperative Hospital Research Articles

Preoperative anemia and total hospitalization time are the independent factors of preoperative deep venous thromboembolism in Chinese elderly undergoing hip surgery

BackgroundThis study was designed to explore the prevalence and risk factors of preoperative deep venous thromboembolism (DVT) in Chinese elderly with hip fracture.MethodsFrom January 1, 2012, to December 31, 2018, 273 elderly patients over 70 years old with elective hip surgery were collected from the electronic medical records. Collected data included demographic characteristics, comorbidities, ASA classification, types of previous operations, types of anesthesia, operation time, fracture to operation time, preoperative hemoglobin level, anemia, blood-gas analysis, cardiac function, whether transfusion, preoperative hospitalization, postoperative hospitalization, electrocardiograph, lower limb venous ultrasonography and total hospitalization time.ResultsIn these 273 patients, 15(5.6%) had ultrasonography evidence of DVT in affected limbs before surgery. Three of all patients received an temporary inferior vena cave filter placement preoperatively. Fracture to surgery time, preoperative hemoglobin level, anemia, preoperative hospitalization, pulmonary disease and total hospitalization time were statistically different between DVT group and non-DVT group (P < 0.05 for all). Moreover, preoperative anemia (OR: 0.144, 95%CI: 0.026–0.799, P = 0.027) and total hospitalization time (OR: 1.135; 95%CI: 1.023–1.259, P = 0.017) were the two independent risk factors for preoperative DVT.ConclusionPreoperative anemia and total hospitalization time were independent risk factors for venous DVT in Chinese elderly with hip fracture.

Impact of posthospital syndrome on outcomes of elective endovascular repair of abdominal aortic aneurysm

ObjectivePosthospital syndrome (PHS) is an acquired, transient period of health vulnerability after a hospital admission for acute illness. It is characterized by physiologic deconditioning secondary to stressors from disruption in circadian rhythm, depletion of nutritional and physiologic reserve as well as the pain and discomfort associated with hospitalization. PHS is reported as an independent risk factor for readmission and adverse postoperative outcomes. The aim of this study is to investigate whether preoperative hospitalization affects outcomes of elective endovascular repair of abdominal aortic aneurysm (EVAR). MethodsThe Healthcare Cost and Utilization Project State Inpatient Database for California (2009-2011) were queried using International Classification of Disease Codes, Ninth Edition, codes of 441.4 (abdominal aneurysm without mention of rupture), 397.1 (EVAR with graft), and 397.8 (EVAR with branching or fenestrated graft). PHS exposure is defined as any inpatient admission 30 or fewer days before elective EVAR. Primary outcomes are all-cause mortality and overall complications. Secondary outcomes include length of stay (LOS), 30-day readmission, and hospital charge. ResultsA total of 6155 patients were identified. of which 327 patients (5.6%) had more than one episode of hospital admission 30 days or less before elective EVAR. In-hospital mortality was comparable after PHS exposure (P = .09). However, PHS exposure was associated with increased 30-day readmission (9.5% vs 18.4%; P < .001), LOS (3.0 vs 4.5 days; P < .001), and overall complications (14.8% vs 24.5%; P < .001). Risk adjustment was made based on age, sex, race, baseline comorbidities, and reason for preoperative admission. Multivariate logistic regression analysis demonstrated that PHS exposure was a predictor for longer LOS (odds ratio [OR], 2.5; 95% confidence interval [CI], 2.0-3.2; P < .001), higher incidence of 30-day readmission (OR, 2.0; 95% CI, 1.4-2.6; P < .001), and overall complications (OR, 1.7; 95% CI, 1.3-2.2; P < .001). Additional cost associated with increased 30-day readmission attributable to PHS exposure was estimated at $448,302 per 100 cases. ConclusionsPHS is an independent risk-adjusted predictor for increased LOS, 30-day readmission, and overall complications after elective EVAR. Recent hospital admission should be assessed carefully before elective EVAR. Medical optimization with an attempt to delay elective surgery by up to 30 days may help to improve surgical outcomes and decrease unnecessary health care expenditures.

Psychological distress before total knee arthroplasty is associated with longer hospital stay after surgery

Purpose: To investigate the association between pre-operative psychological health and hospital length of stay following total knee arthroplasty. Methods: A prospective observational study of 91 participants was conducted at two hospitals in Western Sydney Local Health District, Australia. Participants were scheduled for a unilateral, primary total knee arthroplasty (TKA) and lived within our Local Health District. We excluded those with moderate or severe cognitive impairment or planned orthopaedic surgery within six months of the index TKA. Pre-operative measures included sociodemographic data, anthropometric data, pain, function, leg strength, fatigue, resilience and quality of life. Psychological distress was measured using the Depression, Anxiety and Stress Scale-21 (DASS-21). Participants who reported any level of psychological distress on the DASS-21 before TKA were assigned to the “psychologically distressed” group. All other participants were assigned to the “psychologically well” group. Our primary outcomes were acute hospital length of stay (LOS, in calendar days) and incidence of inpatient complications. Non-parametric methods were used to compare groups on primary outcomes. Generalized linear modelling with Poisson loglinear distribution was used to conduct univariate and multivariate analysis in order to determine pre-operative factors affecting length of stay. Results: Data is presented for 75 participants (16 excluded due to incomplete baseline data, no loss to follow-up) (Figure). The psychologically distressed group had a significantly longer hospital length of stay compared to the psychologically well group (median LOS 5.0 days (IQR 2) vs 6.0 days (IQR 3), Mann Whitney U = 495.500, p = 0.028), with no significant difference in inpatient complications between groups (p > 0.05). Leg strength was the only significant predictor of LOS on multivariate generalized linear modelling (OR -0.972, 95%CI OR 0.946-1.000, p = 0.047). Conclusions: Psychological distress before TKA is associated with longer LOS after surgery. Assessing psychological health needs to be standard care for elective arthroplasty and can be feasibly performed by clinicians already embedded in orthopaedic care. Further research to improve perioperative pathways needs to consider optimizing both psychological and physical health.

The Effect of Left Thoracotomy LVAD Implantation to LVAD Surgery and Followed Heart Transplantation Surgery

Left ventricular assist device (LVAD) implantations have traditionally been approached via full median sternotomy (FS). Recently, minimally invasive left thoracotomy (LT) approach has been popularized with improved surgical technique and emergence of smaller centrifugal LVAD devices. However, the surgical outcomes from minimal surgical approach remains to be unclear. The primary objective was to compare outcomes among patients who received an LVAD via FS compared to LT as well as their subsequent outcomes following heart transplantation. This is a single center retrospective study. 126 patients who underwent primary LVAD implantation from Jan 2014 to June 2018 are included (FS group n=83, LT group n=43). 49 patients had following HT (FS group n=27, LT group n=22). Preoperative patient demographics, intraoperative variables, hospital stay, postoperative survival and complications from LVAD implantation and heart transplantation were analyzed. Preoperatively, FS group had higher right atrial pressure (p<0.05). Intraoperative data showed LT group had 24% longer LVAD implant surgical time (p<0.05). Kaplan Meier curve showed better survival in LT group after LVAD implantation (p=0.04). The 1 year survival rate after heart transplantation was 100% for both groups. For post LVAD complications, FS group had more gastrointestinal bleeding events (p<0.05). There were no significant differences in post heart transplantation complications. Lastly, average length of hospital stay after LVAD implantation and heart transplantation showed no significance, respectively (25.0±24.9 vs 19.3±12.0, p=0.18),(28.2±41.9 vs 21.1± 13.7, p=0.46). Our study showed LT group was associated with improved survival after LVAD implantation. However, our study has limitation of containing bias from retrospective, non-randomized study design. Further, larger studies are warranted to prove the effects of minimally invasive LVAD implantation surgery.

Same Game New Rules: What is the Impact of the 2018 UNOS Heart Allocation Change?

The 2018 UNOS heart allocation policy shifted priority from patients supported with durable devices to those with temporary mechanical support. We sought to quantify the implications of this change including impact on wait times, hospital bed utilization and use of mechanical circulatory support devices. This study was a retrospective review of 32 consecutive patients who underwent heart transplantation at a single center between October 2017 and May 2019. Patient charts were reviewed for information regarding preoperative characteristics, operative data, and perioperative characteristics. Univariate analysis compared demographics and outcomes before and after the October 2018 policy change. There were 16 patients each in the pre and post policy-change groups. Patients did not differ significantly in their demographic profiles. Significant differences were noted, however, in the time on transplant list with median days of 166 before vs. 18.5 after policy change (p= .017), and in the presence of preoperative temporary support (12.5% vs. 68.75%, p= .011). Prior to the allocation change most heart transplant patients were admitted from home on the day of transplant (9/16 vs. 6/16), while afterwards the average preoperative length of stay was 14.7 days with the majority of these days as ICU status (11.06). Operative times were shorter (593 vs. 685 median minute, p= .0026) in the post allocation change group. There was no difference in operating room blood transfusions, postoperative outcomes, or postoperative length of stay between the groups. This study suggests that following the 2018 policy change, patients who received heart transplants experienced shorter waitlist times, longer preoperative hospital stays, and had an increased use of temporary mechanical assist devices. This shift to a resource intensive inpatient management strategy has implications that will require further evaluation.

Expanded transnasal approaches to the skull base in the Middle East: Where do we stand?

ABSTRACTBACKGROUND: Endoscopic transnasal surgery has gained rapid global acceptance over the last two decades. The growing literature and understanding of anterior skull base endoscopic anatomy, in addition to new dedicated endoscopic instruments and tools, have helped to expand the use of the transnasal route in skull base surgery.OBJECTIVE: Report our early experience in expanded endoscopic transnasal surgery (EETS) and approach to skull base neoplasms.DESIGN: Descriptive, retrospective case series.SETTING: Major tertiary care center.PATIENTS AND METHODS: A retrospective case review was conducted at King Saud University Medical City between December 2014 and August 2019. Cases with skull base neoplasms that underwent EETS were included. EETS was defined as endoscopic surgical exposure that extended beyond the sellar margins (prechiasmatic sulcus superiorly, clival recess inferiorly, cavernous carotid lines laterally). Routine transsphenoidal pituitary neoplasms, neoplasms of sinonasal origin and meningoencephaloceles were excluded.MAIN OUTCOME MEASURES: Preoperative clinical assessment, imaging results, surgical approach, and hospital course were all retrieved from the patient electronic charts. Clinical follow-up, perioperative complications, and gross residual tumor rates were documented and reviewed.SAMPLE SIZE AND CHARACTERISTICS: 45 cases of EETS, 13 males and 32 females with mean age of 39.0 (17.7) years (range 2–70 years).RESULTS: The series comprised a wide range of pathologies, including giant pituitary adenoma (8 cases), meningioma (23 cases), craniopharyngioma (4 cases), chordoma (4 cases), optic pathway glioma (2 cases), epidermoid neoplasms (2 cases), astrocytoma (1 case), and teratoma (1 case). For the entire series, gross total resection was achieved in 25/45 operations (55.5%). Postoperative cerebrospinal fluid leak was the most common complication observed in 9 patients (20%) which were all managed endoscopically. Major vascular complications occurred in 2 patients (4.4%) and are described. Other complications are outlined as well. No mortality was observed.CONCLUSIONS: EETS to the skull base can be done with results comparable to traditional approaches. More work is needed to expand our experience, improve outcomes, and educate the public and medical community in our region about the usefulness of this approach.LIMITATIONS: Sample size and study design.CONFLICT OF INTEREST: None.

Factors Associated with the Development of Postnatal Depression After Cesarean Delivery: A Prospective Study.

PurposePre-operative association factors (pain and psychological vulnerability) could significantly contribute to post-Cesarean pain; however, limited information is available on the development of postnatal depression (PND). We aimed to investigate the development of PND and its association with pain vulnerability and psychological vulnerability factors.Patients and MethodsWomen undergoing Cesarean delivery under spinal anesthesia were given pre-operative questionnaires, psychological and pain assessments including pain on local anesthetic injection during spinal anesthesia and mechanical temporal summation. Post-operative assessments were administered at 6 to 10 weeks post-Cesarean delivery via follow-up survey to assess post-Cesarean psychological and pain outcomes.ResultsPND occurred in 21.1% (43 of 205) of patients who underwent elective Cesarean delivery. An increased pre-operative pain score with movement (Odds ratio (OR) 1.65, 95% CI 1.12–2.44, p = 0.0110), anxiety about upcoming surgery (OR 1.02, 95% CI 1.00–1.04, p = 0.0429), higher pre-operative Hospital Anxiety and Depression Scale (HADS) subscale on anxiety (OR 1.25, 95% CI 1.07–1.45, p = 0.0041) and higher pre-operative central sensitization inventory (CSI) scores (OR 1.05, 95% CI 1.01–1.09, p = 0.0156) were independently associated with an increased risk of PND. Anticipated pain medication needs were associated with reduced risk of PND (OR 0.48, 95% CI 0.29–0.79, p = 0.0038) (Receiver operating characteristic (ROC) = 0.8177).ConclusionHigher pre-operative anxiety, pain score, central sensitization and lower anticipated pain medication needs were associated with increased risks of PND. Further work using larger sample size will be needed to validate the model in predicting PND development after Cesarean delivery.

Immediate Surgery in Acute Type A Dissection and Neurologic Dysfunction: Fighting the Inevitable?

Neurologic dysfunction remains an ongoing challenge in the diagnosis of type A aortic dissection (AAD). Our study analyzed the impact of preoperative neurologic dysfunction (PND) on outcome and assessed a potential link between PND and specific patterns of postoperative neurologic injury. Medical records of 338 patients (70.1% men; mean age, 59.3 ± 13.7 years) undergoing surgical repair for AAD were screened for the presence of PND. Preoperative characteristics, surgical treatment, and hospital and neurologic outcomes were analyzed according to patients with PND (PND+) and without PND (PND-) RESULTS: There were 50 patients (14.8%) admitted with PND. PND+ patients showed significantly higher rates of postoperative neurologic injury (44.4%) than PND- patients (14.3%; P < .001) with a specific pattern of ischemic lesions in accordance with preoperative neurologic status. While PND+ patients suffered mainly from right hemispheric strokes (66.7% vs 32.4% in PND- patients, P= .024), PND- patients more frequently presented with bilateral cerebral ischemia (56.8% vs 13.3% in PND+ patients, P= .004). Multivariable analysis identified presence of PND (odds ratio, 2.977; 95% confidence interval, 1.357-6.545) as an independent predictor for new postoperative neurologic injury. PND was associated with impaired survival (P= .005). This study identified an association of preoperative neurologic status and specific stroke patterns after surgical repair of AAD. Irrespective of timing of surgery and reperfusion strategies, preoperative neurologic dysfunction is strongly associated with impaired neurologic outcome.

Prevalence and root causes of surgical site infections at an academic trauma and burn center in Ethiopia: a cross-sectional study

BackgroundDespite modern surgical techniques and the use of antibiotic prophylaxis, surgical site infection remains a burden for the patient and health system. It is a major cause of morbidity, prolonged hospital stay, and increased health costs. Thus, the main aim of this study was to determine the prevalence and root causes of surgical site infection among patients undergoing major surgery at an academic trauma and burn center in Ethiopia.MethodsA hospital based cross-sectional study was conducted on 249 patients during 6-months’ time window. Data entered in SPSS and multivariate logistic regression was employed to determine the root causes and the outcome variable.ResultsThe prevalence of surgical site infection was found to be 24.6% of whom 10% develop deep site, 9.2% organ spaced and the remaining 5.2% develop superficial space surgical site infection. The prevalence was high in patients who had undergone orthopedics (54.3%) and abdominal (30%) surgeries. Educational status, pre-morbid illness, duration of pre-operative and post-operative hospital stay, ASA score, and type of the wound were significantly associated with SSI at p-value of ≤0.05. However, no association was found with BMI and location of the wound.ConclusionsThe prevalence of surgical site infection in the study population is still high. Preoperative hospital stay, pre-morbid illness, pre-operative and post-operative hospital stay, ASA score, and type of the wound were the independent predictors of surgical site infection. The duration of pre and post-operative periods should be kept to a minimum as much as possible. Patients with pre-morbid history of chronic diseases and contaminated wound require special attention to decrease the rate of occurrence of infections. In addition, longitudinal studies should be carried out to identify more risk factors.

&lt;strong&gt;Impacts of Preoperative Smoking and Smoking Cessation Time on Preoperative Peripheral Blood Inflammatory Indexes and Postoperative Hospitalization Outcome in Male Patients with Lung Cancer Surgery&lt;/strong&gt;

&lt;strong&gt;Impacts of Preoperative Smoking and Smoking Cessation Time on Preoperative Peripheral Blood Inflammatory Indexes and Postoperative Hospitalization Outcome in Male Patients with Lung Cancer Surgery&lt;/strong&gt;

Impact of perioperative blood transfusion on oncologic outcomes in patients with nonmetastatic renal cell carcinoma treated with curative nephrectomy: A retrospective analysis of a large, single-institutional cohort.

PurposeTo evaluate the impact of perioperative blood transfusion (PBT) on oncologic outcomes after surgery in patients with nonmetastatic renal cell carcinoma (RCC).Materials and MethodsThis retrospective review included 2,329 patients who underwent partial or radical nephrectomy for localized RCC in a single institution from 2000 to 2014. PBT was defined as transfusion of allogeneic packed red blood cells (pRBCs) during nephrectomy or within the preoperative or postoperative hospitalization period. Oncologic outcomes of interest were recurrence-free survival (RFS), overall survival (OS), and cancer-specific survival (CSS).ResultsPBT was performed in 275 patients (11.8%). In the multivariable logistic regression analysis, symptomatic presentation, advanced age at surgery, higher preoperative serum creatinine, and lower preoperative hemoglobin were independent preoperative risk factors for PBT (all p<0.05). Kaplan–Meier plots revealed that transfused patients showed poorer 5-year RFS (65.1% vs. 91.2%, p<0.001), OS (71.4% vs. 92.8%, p<0.001), and CSS (74.0% vs. 95.5%, p<0.001) than nontransfused patients. However, in the multivariable Cox regression analyses, PBT was not significantly associated with RFS, OS, or CSS. In multivariable analyses involving transfused patients only (n=275), an higher number of pRBC units was an independent predictor of worse OS (hazard ratio [HR], 1.043; 95% confidence interval [CI], 1.008–1.078; p=0.016) and CSS (HR, 1.066; 95% CI, 1.033–1.100; p<0.001).ConclusionsThe results of this study are inconclusive in that the influence of PBT on survival outcomes could not be determined in the multivariate analysis. However, increasing pRBC units in transfused patients might be a concern in light of worse OS and CSS. Therefore, efforts to limit PBT overuse seem necessary to improve postoperative survival in patients with RCC.

Evaluation of post-operative development of mediastinitis in patients undergoing isolated coronary artery bypass grafting surgery: A single-center experience.

In this study, we aimed to evaluate mediastinitis cases developed after isolated coronary artery bypass graft surgery performed by median sternotomy to determine the causative microorganisms, risk factors, and clinical features. Between March 2009 and December 2018, a total of 44 patients (32 males and 12 females; mean age 62.84±6.951 years; range, 46-78 years) who underwent isolated coronary artery bypass grafting surgery with median sternotomy and developed mediastinitis postoperatively were included in the studying our cardiovascular surgery (CVS) department. Patients demographic information, comorbidities, habits, pre-operative hospital stay, elective or emergency surgery, perioperative internal mammary artery use, perioperative blood or blood product, operation and cardiopulmonary bypass times, suitability of antibiotic prophylaxis, medical and surgical treatment, clinical data, and laboratory results were retrospectively analyzed. Purulent discharge cultures obtained directly from the mediastinal space and microbiological examination notes made from the material obtained from the surgical site or surgical repair were recorded. In isolated coronary artery bypass grafting surgery performed over a period of approximately 10 years, the rate of mediastinitis was 1%. There was no statistically significant difference between patients with and without mediastinitis in terms of age, sex, smoking habits, duration of operation and cardiopulmonary bypass, and intraoperative blood transfusion. The presence of diabetes mellitus and high mean body mass index was significantly higher in patients with mediastinitis compared to those without. Mediastinitis was diagnosed in 38 (86.3%) patients in the 1st month, 5 (11.3%) in the first 3 months, and 1 (2.2%) in the 1st year. Twenty-five (56.9%) Gram-positive bacteria, 13 (29.6%) Gram-negative bacteria, and 1 (2.3%) fungi were the microorganisms grown in purulent discharge cultures. Pathogen microorganisms could not be produced in 5 (11.4%) cases. The three most commonly isolated agents were methicillin-resistant coagulase-negative staphylococci (MRCNS) (50%), Escherichia coli (9.1%), and Klebsiella pneumoniae (6.8%). Attention should be paid to surgical site infection in patients undergoing CVS. Following discharge, follow-up is important and empirical treatment should be determined by considering the presence of MRCNS as the leading infectious agent in our hospital when infection occurs.

Intramedullary nailing versus minimally invasive plating in the treatment of distal tibial extra-articular fractures: Comparison of cost-analysis in Turkey

Background Minimally invasive percutaneous plate osteosynthesis (MIPO) and intramedullary nailing (IMN) are the two most commonly used methods for distal tibial extra-articular fractures; however, the ideal treatment is still on debate. The aim of this study was to compare MIPO and IMN in the treatment of distal tibial extra-articular fractures in terms of cost analysis according to health insurance records in Turkey. Methods The data of patients who underwent either MIPO or IMN for the treatment of distal tibial extra-articular fractures between 2013 and 2018 were analyzed in this retrospective study. Patients' clinical data, as well as the overall expenses from the first admission until return to work including hospitalization, and all outpatient controls had been reviewed from the hospital's billing department. The total amount of money paid per month by Turkish National Social Security Institution to the patient until the patient's returns to work were also recorded. Results 118 consecutive patients (35 female-83 male) with the mean age of 37.2±13.4 were participated to the study. IMN group consisted of 57 patients with a mean age of 36.7±12.8 years, and MIPO group consisted of 61 patients with a mean age of 37.8±13.6 years. No significant differences were observed between study groups in terms patients' age, gender, fracture classification (AO/OTA: Arbeitsgemeinschaft fur Osteosynthesefragen/Orthopedic Trauma Association), soft-tissue injury (Tscherne classification), presence of type 1 open fracture, and presence of accompanying fibula fracture. There was no statistical difference between two groups in terms of pre-operative hospital stay (p=0.713). However, the mean length of hospital stay was significantly higher in the MIPO group (p= Conclusion According to the results acquired from the present study, IMN is a better option compared to MIPO for the treatment of extra-articular distal tibial fractures in terms of costs paid by the national health insurance in Turkey.

Prevalence and factors associated with re-laparotomy among patients operated in Debre-Markos referral hospital, north west Ethiopia: Retrospective cross-sectional study

BackgroundRe-laparotomy is one of the causes of morbidity and mortality among patients with abdominal surgery; unless efforts are made to prevent it in advance by identifying its potential risk factors. ObjectiveThe study aimed to assess the prevalence and factors associated with re-laparotomy. MethodsA Retrospective cross-sectional study was conducted on 390 charts at Debre-Markos referral hospital from three hundred and ninety charts (390) from January 1, 2015, to January 30, 2017. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 22. The associated factors for re-laparotomy were identified using multivariable logistic regression. P-values < 0.05 were considered to be statistically significant. ResultsA total of 422 charts, 116 (29.7%) and 274(70.3%) of which belonged to males and females, respectively, were retrieved. Both groups of patients were in the age range of 7–27 years. Of those 390 (92%) charts found complete, 48 (12.3%) were identified with re-laparotomy. The majority of 274 (70.3%) of the participants of the study were male. Initial operations which took over 60 h (AOR = 3.30(95%CI [1.40–7.41, p = 0.05]), diabetes mellitus, AOR = 4.79 (95%CI [1.55–14.80, p = 0.007]) and elective surgeries AOR = 0.17 (95%CI [0.05–0.56, p = 0.004]). Patients with the duration of operating on initial surgery > 60 hrs, elective surgery, were associated with re-laparotomy at Debre-Markos referral hospital. ConclusionThe overall prevalence of re-laparotomy found to be high. Examining and identifying high-risk patients and accordingly taking all appropriate care should be done to decrease the risk of re-laparotomy. Shortening the preoperative hospital stay and duration operation further decrease the prevalence of re-laparotomy.

Cardiothoracic surgery during COVID-19: Our experience with different strategies.

Background:An acute respiratory disease (COVID-19), caused by a novel coronavirus (SARS-CoV-2,), has been declared a pandemic by WHO. A surgery on COVID-19 patients not only involves a risk of spread of the disease but also there is a serious concern for the patient's surgical outcomes and resources requirement.Aim:The retrospective study is aimed to provide a protocol for pre-operative testing of SARS CoV-2 using RT-PCR in the patient undergoing cardio-thoracic surgeries.Material and Methods:To analyze the impact of pre-operative testing of SARS- CoV-2 using RT-PCR in the patient undergoing elective cardio-thoracic surgeries. The patient who underwent surgical interventions during the COVID-19 lockdown period was divided into two phases. Phase I (without COVID-19 RT-PCR testing) and Phase II (with pre-operative COVID-19 RT-PCR testing). The retrospective comparison between the two study groups was done using Student t-test, Mann–Whitney U, and Chi square (χ2) test depending upon the clinical variable to be analyzed.Results:During the early phase (phase I), 26 patients underwent cardio-thoracic surgery without COVID-19 RT-PCR test. Whereas, during phase II, all patients were tested for COVID-19 using RT-PCR, preoperatively and a total of 64 surgeries were performed during this phase. One patient planned for CABG was positive on RT-PCR for COVID-19 and was sent to the quarantine ward. The difference in the pre-operative hospital stay between two groups was found to be statistically significant and a significant decrease in the number of PPE kits used, during the phase I.Conclusion:All asymptomatic patients should be tested for COVID-19 using RT-PCR prior to cardio-thoracic surgeries not only to contain the disease but to avoid potential implications of COVID-19 on the perioperative course, without added financial implications.

Nutrition Counseling Position in Reducing the Duration of Admission for Patients with Type 2 Diabetes Undergoing Cataract Surgery

Background and Aim: Cataract is one of the most common ocular diseases caused by various causes including congenital, resulting from trauma, drug or radiation, diabetes, or aging. Diabetes type 2, as a common metabolic disorder, is one of the main reasons for cataracts. we aimed to study nutritional counseling's status on the correction of glucose and urea and creatinine patterns and blood pressure of patients undergoing cataract surgery and reducing the pre-operative hospitalization time. Methods: In this study, 60 women with type 2 diabetes and 39 male participants aged 25 to 65 (aged 25 to 65) were randomly assigned into two groups (control without diet and nutritional counseling). The target group (presentation of diabetic diet and nutrition counseling) went under investigation two weeks before cataract surgery. Blood sampling proceeded from the arm vein in a sitting way one day before and after the diet (12 hours of fasting). Results: Fasting blood glucose, body weight, waist circumference, urea, creatinine, blood pressure, and hospitalization period were significantly decreased after surgery (p≤0.05). Conclusion: The results showed that receiving nutrition counseling and diet before cataract surgery can improve fasting blood glucose, 2-hour blood glucose, body weight, urea, creatinine, blood pressure, and thus hospitalization and recovery be reduced after surgery. *Corresponding Author: Fariba Mohammadi Tahroodi; Email: faribamt93@yahoo.com Please cite this article as: Vaziri Javid R, Safizadeh F, Lotfi F, Pouriamehr S, Khonakdar-Tarsi A, Akbari Javar A, Zarpou S, Mohammadi Tahroodi F. Nutrition Counseling Position in Reducing the Duration of Admission for Patients with Type 2 Diabetes Undergoing Cataract Surgery. Arch Med Lab Sci. 2019;5(4): 37-43. https://doi.org/10.22037/amls.v5i4.30082

Dampak kecemasan terhadap pemenuhan pola istirahat tidur pada pasien pre-operasi di ruang rawat inap RSUD Kota Langsa

Background: Rest and sleep are basic needs of all people. Normally, everyone needs adequate rest and sleep. Factors that influence this pattern are feelings of anxiety. Fear of the unknown and surgical procedures will be the most common cause for inpatients to feel as a form of anxiety.Objectives: Study aims to measure the level of anxiety level relationship with the fulfillment of restful sleep patterns in patients with pre-surgery in the inpatient room of Langsa City Hospital.Methods: The study was used analytic research design with cross sectional approach. The population in this study were all pre-operative patients with a total sample of 43 respondents taken using accidental sampling techniques. Processing is done computerized with the stages of editing, coding, tabulating and cleaning. Data analysis used chi-square test with the desired confidence level of 95%. Research data is presented in tabular and textular forms.Results: Most of the patients (53.5%) had moderate anxiety level and amounted to only 30.2% who experience mild anxiety. Statistically significant correlation (p &lt; 0.05) between the level of anxiety to the fulfillment of restful sleep patterns in patients with preoperative hospitalization diruang Hospital Langsa, with p = 0.001.Conclusion: Anxiety inpatients have a significant impact on fulfilling sleep rest patterns in pre-operative patients in the inpatient room of Langsa City Hospital. Suggestion, it is necessary to provide a specific explanation by nurses about the surgical actions to be performed pre-operative patients.

Preoperative and operation-related risk factors for postoperative nosocomial infections in pediatric patients: A retrospective cohort study.

Pediatric patients undergoing invasive operations bear extra risk of developing nosocomial infections (NIs). However, epidemiological evidence of the underlying risk factors, which is needed for early prevention, remains limited. Using data from the electronic medical records and the NI reporting system of a tertiary pediatric hospital, we conducted a retrospective analysis to identify preoperative and operation-related risk factors for postoperative NIs. Multivariable accelerated failure time models were fitted to select independent risk factors. The performance of these factors in risk stratification was examined by comparing the empirical risks between the model-defined low- and high-risk groups. A total of 18,314 children undergoing invasive operations were included for analysis. After a follow-up period of 154,700 patient-days, 847 postoperative NIs were diagnosed. The highest postoperative NI rate was observed for operations on hemic and lymphatic system. Surgical site infections were the NI type showing the highest overall risk; however, patients were more likely to develop urinary tract infections in the first postoperative week. Older age, higher weight-for-height z-score, longer preoperative ICU stay, preoperative enteral nutrition, same-day antibiotic prophylaxis, and higher hemoglobin level were associated with delayed occurrence of postoperative NIs, while longer preoperative hospitalization, longer operative duration, and higher American Society of Anesthesiologists score showed acceleration effects. Risk stratification based on these factors in an independent patient population was moderate, resulting in a high-risk group in which 72% of the postoperative NIs were included. Our findings suggest that pediatric patients undergoing invasive operations and at high risk of developing postoperative NIs are likely to be identified using basic preoperative and operation-related risk factors, which together might lead to moderately accurate risk stratification but still provide valuable information to guide early and judicious prevention.

Risk factors of short-term survival in the aged in elective colon cancer surgery: a population-based study

PurposePatients aged > 80 years represent an increasing proportion of colon cancer diagnoses. Selecting patients for elective surgery is challenging because of possibly compromised health status and functional decline. The aim of this retrospective, population-based study was to identify risk factors and health measures that predict short-term mortality after elective colon cancer surgery in the aged.MethodsAll patients > 80 years operated electively for stages I–III colon cancer from 2005 to 2016 in four Finnish hospitals were included. The prospectively collected data included comorbidities, functional status, postoperative surgical and medical outcomes as well as mortality data.ResultsA total of 386 patients (mean 84.0 years, range 80–96, 56% female) were included. Male gender (46% vs 35%, p = 0.03), higher BMI (51% vs 37%, p = 0.02), diabetes mellitus (51% vs 37%, p = 0.02), coronary artery disease (52% vs 36%, p = 0.003) and rheumatic diseases (67% vs 39%, p = 0.03) were related to higher risk of complications. The severe complications were more common in patients with increased preoperative hospitalizations (31% vs 15%, p = 0.05) and who lived in nursing homes (30% vs 17%, p = 0.05). The 30-day and 1-year mortality rates were 6.0% and 15% for all the patients compared with 30% and 45% in patients with severe postoperative complications (p < 0.001). Severe postoperative complications were the only significant patient-related variable affecting 1-year mortality (OR 9.60, 95% CI 2.33–39.55, p = 0.002).ConclusionsThe ability to identify preoperatively patients at high risk of decreased survival and thus prevent severe postoperative complications could improve overall outcome of aged colon cancer patients.

Comparative analysis of treatment of patients with neck fractures of the femur

Purpose of the study. Based on the analysis of case histories to determine ways to improve the results of treatment of patients with hip fracture and reduce duration of rehabilitation period. Material and methods. From 2012 to 2018 in the emergency department of traumatology of the Sklifosovsky Clinical and Research Institute for Emergency Care were treated 865 patients with a hip fracture. For analysis of these patients they were divided into 2 groups. The control group consisted of patients who were treated from 2012 to 2016 - 569 patients. The main group - 296 patients treated from 2017 to 2018. Results. Preoperative hospital stay in the main group was reduced in the 2-fold. The number of non-operated patients was reduced by 2 times. It was increased in the number of hip arthroplasty from 46.3% to 53.0%. It reduces the average time of operation in bipolar arthroplasty from 65 to 48 minutes, in total arthroplasty - from 89 to 63 minutes. It reduces the average blood loss during arthroplasty from 626 ml to 277 ml. The preoperative thrombosis of the lower limbs was detected in 9% of primary and 15% of the control group. Number of bedsores decreased from 2.5% to 1.7% and reduced mortality from 3.3% to 1.3%. Conclusion. All patients with a suspected fracture of the proximal femur, regardless of age, should be admitted and examined. Indications for surgery are vital. The purposes of the examination of the patient are identifying ways to quickly patient's condition compensation. For the prevention of thromboembolic complications is necessary to perform venous ultrasound before and after the operation. Detection of floating thrombus in the veins of the lower extremities before surgery is an indication for surgical prophylaxis of thromboembolism. Diagnosing floating thrombus up to 5 cm in the postoperative period may be an indication for conservative treatment. Such measures as multimodal analgesia with combination of non-steroidal and opioid analgesics before and after operation, patient-controlled analgesia in the postoperative period, high volume surgical wound infiltration with a solution of local anesthetic during surgery allows to activate the operated patients for 1-2 days after hip replacement. Reducing the duration of the operation leads to reduction of blood loss during the arthroplasty by improving the surgical technique and intravenous tranexamic acid infusion.